Health and Social Care Bill

Lord Beecham Excerpts

Wednesday 2nd November 2011 Lords Chamber

Moved by

[Lord Beecham]

7: Clause 1, page 2, line 7, at end insert—
“( ) For the purposes of this Act “the health service in England” is defined as those services provided under section 3 of this Act.”

[Lord Beecham]

My Lords, I rise to move this amendment in my name and those of my noble friends Lady Thornton and Lord Hunt of Kings Heath. As we make steady progress through this Bill, your Lordships will encounter many amendments more elegantly drafted than this one, I have to admit. Given the evident affection in which lawyers are held in your Lordships’ House, I trust that this member of the junior branch of the profession will be forgiven for the drafting of this amendment, especially as I was not responsible for it—

[Baroness Thornton]

You are.

[Lord Beecham]

But I did subscribe to it. There is a sort of collective responsibility on these Benches, too.

This is a probing amendment—it could hardly be anything else in the circumstances—that tries to deal with what actually constitutes the health service. Of course, this phrase runs through the Bill but there is not within the Bill a definition of what constitutes the health service, let alone “a comprehensive health service”—the words used in Clause 1, which we will be returning to on Report. The amendment seeks to add to Clause 1(3) and the intention is to reflect Section 3 of the 2006 Health Act, which laid out clearly, to a reasonable extent at any rate, the scope of the Secretary of State’s duties. The Secretary of State was obliged to,

“provide throughout England, to such extent as he considers necessary to meet all reasonable requirements”

broadly six categories of service, amplified in Schedule 1 to the Act by more detailed requirements around medical inspection for pupils at schools and issues of that kind.

It clearly is impossible to lay down in legislation everything that might be brought within the purview of the Secretary of State or indeed any other body for the purposes of defining precisely what a national health service should be and what would constitute a comprehensive health service. Clause 10 in any event transfers some of those responsibilities to commissioning groups, as the noble Lord, Lord Marks, has pointed out, but it is not entirely clear from the clause, to put it mildly, what functions will be included in their responsibilities.

--- Later in debate ---

[Lord Newton of Braintree]

Will the noble Lord explain what he actually wants, because I am now thoroughly confused? First, he seeks the reincarnation of a section of the 2006 Act, which, if I remember rightly, was a consolidation Act—in other words, merely a record of what had already happened in history. He then goes on to say that he does not want to ossify—although he did not use that word—the service; he wants flexibility but accepts that it is not possible at any one time to define everything that the service provides. I simply do not know what he is saying.

[Lord Beecham]

My Lords, I am saying that the Bill should lay down at this stage a range of services that will be part of a national health service but that that should not be limited by reference to a particular moment. There will have to be flexibility, but the Bill should clearly indicate, as the 2006 Act did, areas that, taken together, constitute a national health service. It is a simple enough proposition. The content would have to be debated as we go forward, but this is a probing amendment that is designed to ventilate the issue in the hope that some consideration might be given in the course of proceedings on the Bill to the changes that are required.

Ultimately, some decisions will have to be taken about what services are to be provided, not least about the services in Clause 1(3) that must be provided free of charge. People are entitled to know what services they will get free of charge at any given time. As I have said, at some point these matters should be elaborated. There is also an issue about how public health services are to be regarded in the light of the Bill’s current proposals; for example, in relation to the role of Monitor, competition issues and the like.

Amendment 7 seeks to establish a method of taking this discussion forward so that all of us may be clearer about what we are entitled to expect of a National Health Service and, for the purposes particularly of new Section 1(3) of the National Health Service Act 2006, what services would be provided free of charge. I hope that we can look at that matter and perhaps return to it on Report. In that light, I beg to move.

[The Earl of Listowel]

I thank the noble Lord, Lord Beecham, for moving this amendment and for giving us an opportunity to discuss a definition of the services of the National Health Service. Perhaps the Committee will forgive me if I make now the arguments that I had hoped to make in the later debate on mental and physical health in the health service, for which I am unable to be present. Those arguments are also pertinent to this amendment.

I seek reassurance from the Minister that the new arrangements for the health service will have a specific duty to focus on support of the relationship between the parent and the child, or whoever is acting in loco parentis for that parent, particularly during the early years and in adolescence. Professionals say that adult mental health hinges on the relationships between the primary carers and the child in early life and in adolescence.

The Government’s White Paper highlighted that mental health is important to public health. It follows that in the future we have to be even more careful to ensure, without being overly intrusive, that the relationships between parents and children in the earliest years and in adolescence are as supportive as possible. The health service should have an important role in that. For instance, there is tremendous pressure to generate more early years nursery places. In a recession, we want parents to work and to help build capacity. Nurseries need to be cheap, yet we know that high-quality early years intervention is crucial to better outcomes for children. We also know that the people who work in those settings are often underpaid and not properly supported, and that there can be a high turnover of staff. In driving people, for understandable reasons, to use nursery provision more, there is a danger that the relationship between the parent and the child could be undermined.

The evidence indicates that high-quality early years education produces better outcomes in school for children. Professor Jay Belsky at the University of London investigated this issue. Exposure to poor-quality early years education and nursery care over a number of years can have serious, although small, deleterious effects. But if a lot of children go through these experiences, the overall impact can be significant. It is very hard to measure—this is probably why it does not get prioritised enough—what difference it makes if there is not sufficient support for relationships between parents and children in the earliest years and in adolescence. It is easy to measure cognitive performance in schools, whereas the relationship between parent and child in the earliest years and adolescence is hard to measure. However, qualitatively I am very clear, after consulting with colleagues in the mental health profession, that it is hugely important to get that support right.

I know that the Department of Health works closely with early years services to try to offer such support, but there are still shortcomings. For instance, there is not sufficient support in adult mental health services for adults as parents in children’s centres, and more work could be done. An old chestnut is that, if a parent is presenting with mental health issues, thought is not always given to the fact that the parent has children who will have needs. If a parent is mentally ill, what are the mental health needs of the children? Again, if a child presents with mental health problems, a proper assessment needs to be made to look at whether perhaps the best input is to support the parents. That may help the child to get better.

Noble Lords will be pleased to know that I will not say much more. A few years ago I remember working with a young man who was just coming out of adolescence. His father was an alcoholic and he had experienced domestic violence in his home. I was seeing him and working with him once a week for six months. The issues he had were that he was experiencing growing paranoia, he was fearful and distrustful of the staff, he was mercurial and unpredictable in his behaviours and he had a difficult relationship with women. If there had been better support for that family, perhaps the nascent problems we saw at the time could have been nipped in the bud and he would not have had those difficulties.

I am sorry if I am not explaining myself sufficiently clearly, but I would be grateful if the Minister could reassure the Committee that in any of the new arrangements there will be a particular focus on getting in early to support families, both parents and those acting in the role of parents, in their relationships with their children to make sure that those relationships are strong. Children will then have a good basis from which to grow and enter adulthood. I hope that that will be a priority in the new arrangements.

--- Later in debate ---

[The Earl of Listowel]

I thank the Minister for providing me with the strong assurance that to him and his colleagues the strengthening of the parent/child relationship is absolutely crucial in what they are doing. There is strong agreement with that point and I thank him for that. I will look forward to reading with interest in Hansard the later discussion on mental health.

The Minister mentioned the availability of essential services. To highlight the current concerns, an effective and well respected foster care charity operating in all the nations of the United Kingdom had to create its own child and adolescent mental health services in Wales because there was so little available in that nation. On children’s homes, it has been recognised for a long while that often our most vulnerable children are placed in children’s homes with staff who are poorly equipped to meet their needs. There have been important steps forward in improving that situation but, crucial to that, is ensuring that those staff get the mental health support they need. That is becoming more widely available over time, but it is still piecemeal. We need to ensure that those kinds of situations do not continue into the future.

I am grateful for the Minister’s assurances about the Government’s priorities in this area and, as I say, I look forward to reading the debate in Hansard.

[Lord Beecham]

My Lords, I am grateful to the noble Earl, Lord Listowel, for once again bringing his expertise on this issue. He is perhaps the leading proponent in your Lordships’ House of the concerns around children’s health and other matters relating to children, and his contribution today certainly falls in line with our experience of his many contributions in that area of policy.

I am also grateful to the Minister for his reply. I did not, and the amendment does not, suggest that we should have an exhaustive, finite list of responsibilities or functions which comprise the National Health Service. That would clearly be inappropriate. I thought I had made that clear but perhaps failed to do so. The noble Lord rightly pointed out that, under Clauses 10 and 11, responsibilities are effectively transferred from the Secretary of State to clinical commissioning groups. Had this amendment been taken forward, it would have identified for those groups the services which they should carry out. Of course, the transfer imposes the duty to arrange for the provision of services to the extent that each commissioning group considers necessary. That provision raises the question of the extent to which there is still a commonly accepted view of a National Health Service. That is an open question that we will no doubt return to in different forms as we go forward, but in the circumstances I beg leave to withdraw the amendment.

Amendment 7 withdrawn.